Photopneumatic Therapy for the Treatment of Keratosis Pilaris
July 2013 | Volume 12 | Issue 7 | Original Article | 804 | Copyright © 2013
Heather Ciliberto MD,a Arta Farshidi MD,b David Berk MD,b and Susan Bayliss MDa
aDepartment of Internal Medicine, Division of Dermatology, Washington University School of Medicine, St. Louis, MO
bWashington University School of Medicine, St. Louis, MO
BACKGROUND: Current treatment options for keratosis pilaris (KP) are limited and are often found to be unsatisfactory to patients.
OBJECTIVE: Pilot study to determine if photopneumatic therapy (PPx) can improve the erythema and skin texture in KP.
METHODS: Ten patients with KP were treated with one session of PPx on the upper arm and then evaluated one month later for treatment efficacy.
RESULTS: Average investigator-assessed improvement was 27% in erythema and 56% in skin texture roughness. Average patient self-reported improvement was 52% in erythema and 53% in skin texture. The mean satisfaction score was 6.3 on a scale of 1 to 10 (median 7.5) and 8 out of 10 participants reported they would choose to receive PPx for their KP again in the future.
LIMITATIONS: Small number of patients, short follow-up period, and lack of blinding of the examiner and the patients making recall bias possible.
CONCLUSIONS: One treatment of PPx improved both the erythema and redness associated with KP over at least a one month period.
J Drugs Dermatol. 2013;12(7):804-806.
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Keratosis pilaris (KP) is a common disorder featuring grouped keratotic follicular papules with varying degrees of perifollicular erythema. Lesions are characteristically located on the extensor surfaces of the upper arms, thighs and buttocks, but may also appear on the lateral cheeks or trunk.1-3 Patients often complain of persistently rough-textured skin in these areas. It is a benign autosomal dominant disorder with variable penetrance that is generally asymptomatic but can occasionally be pruritic.3,4 Individuals can also suffer from psychological distress associated with the perceived poor cosmetic appearance. KP can spontaneously improve with age but has an estimated prevalence of 50% during adolescence, with females being disproportionally affected.1 The onset or severity of KP may be related to hormonal changes during puberty or pregnancy.5 Typical treatment options include emollients and other dry skin care habits such as gentle soap-less cleansers, keratolytics and mild topical steroids. Topical retinoids and calcineurin inhibitors have also been tried. However, many patients report disappointing results with these treatment options. Recently, there have been a few reports involving the use of lasers including Q-switched 1064-nm Nd:YAG, 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser and microdermabrasion.6-10 To our knowledge, there have been no reports on the use of photopneumatic therapy (PPx) for the treatment of KP. This treatment option combines light-based therapy with a pneumatic component to address both the follicular plugging and inflammation seen in KP. We present 10 patients with KP on the upper arms treated with one session of PPx and then evaluated one month later for treatment efficacy.
Ten patients who presented to the general medical or pediatric dermatology clinic with KP were invited to participate in the study. Institutional review board approval from Washington University was obtained for this study and informed consent was obtained from all participants for PPx treatment. None of the patients were currently using any form of treatment for their KP and they were instructed not to use any other treatments throughout the duration of the study. One half of each patient’s upper arm was treated using a portable photopneumatic device (Isolaz, Aesthera Co., Pleasanton, CA, USA) with the following settings: vacuum 3, light 5 with 2 passes to the treatment area. No topical anesthetics or cooling gels were needed. All participants were given a baseline evaluation of the redness and skin texture roughness of their KP by the study investigator (SJB) on a scale of 1 to 3 (1 = mild, 2 = moderate and 3 = severe). Clinical improvement was evaluated one month after the treatment by the same investigator and the participants filled out a post-treatment questionnaire rating the improvement in their redness and roughness on a scale of 0% to 100%. In addition, the participants rated their overall satisfaction with the treatment on a scale of 1 to 10 (1= least satisfied, 10 = most satisfied) and were questioned on the comparison of the PPx with any previous treatments they had tried for KP. Any adverse effects of the treatment were documented at the follow-up visit including any erythema, purpura, hypo- or hyperpigmentation, blistering or scarring. This was an investigator-initiated study. No part of the study was overseen or funded by the device manufacturer.
The average age of the participants was 29 years (range 13-45 years), with one male and nine females. The patients had Fitzpatrick skin types I-III. The investigator’s average improvement in erythema was 27% and in skin texture roughness was 56%.